Medicaid anti-fraud effort launched

Some doctors worry it unfairly will target those making innocent errors.

By Elaine Monaghan, AMNews staff. April 17, 2006.

Washington -- Armed with millions of dollars in this year's budget and scores of new staff members, the federal government is preparing a war on Medicaid fraud, projected to rob federal coffers of up to $39 billion by 2016.

The Centers for Medicare & Medicaid Services told AMNews it was too soon to say whether the effort would lead to more audits for physicians. But the push is clearly on for the agency to reduce the billions of dollars believed to be lost each year through fraud and abuse.

This year's budget includes $5 million, which will increase to $75 million by 2009, for a CMS program to tackle abuse in a systematic way.

The law instructed the agency to hire 100 people to combat fraud. The Government Accountability Office found there were eight such workers in 2005. The GAO noted that those staff numbers were grossly out of balance with the government's share of Medicaid benefit payments, which stood at $168 billion in fiscal 2004.

The Medicaid Integrity Program, in its embryonic stage, is supposed to force CMS to report annually to Congress and make an effort to work with states to save money. As incentive, states are to be rewarded with matching funds for money they save by enacting false-claims acts in their states.

A key focus of the federal effort will be on creating a truly national campaign to compare claims filed in Medicaid and Medicare. This identifies patterns of potentially fraudulent behavior that would go unnoticed alone. For example, the government says it can find "time bandits" by looking at Medicaid and Medicare bills side by side. It cited a case in which an individual billed both programs for 16 hours of work in the same 24-hour period.